E-Cigarette Use in Youth May Help Predict Future Use

Tobacco and electronic cigarette (e-cigarette) use and dependence is not only commonly seen among youth and adolescence, but it is also a cause for concern since the brain is still developing and vulnerable to dependence risk. According to new study findings, which were published online in JAMA Network Open, researchers found that e-cigarette dependence may be an expression of tobacco use disorder associated with future use persistence and escalation among youth. 

“Understanding the prevalence and symptoms of e-cigarette dependence and its association with future e-cigarette use among youth may help to guide pediatric clinical services and health policy,” wrote Erin Vogel, PhD, Stanford University, and colleagues. 

“Presently, electronic cigarettes (e-cigarettes), which provide pulmonary nicotine and therefore possess high dependence potential, are the most popular tobacco product among US youth.”  

Dr Vogel and her team conducted a prospective cohort study in order to understand whether e-cigarette dependence is associated with subsequent e-cigarette use patterns 6 months later among youth with baseline past-year e-cigarette use.  

The research team observed students in the 12th grade during the 2016 to 2017 school year who reported any past-year e-cigarette use. The students were given surveys that consisted of a self-reported checklist of 10 tobacco product dependence symptoms reflecting loss of control over use, craving or urge, or withdrawal symptoms while abstinent. These surveys were completed at baseline and administered separately for e-cigarettes and combustible cigarettes.  

In total, the researchers surveyed 3168 twelfth-grade students at baseline including 444 youths (mean [SD] age, 17.48 [0.39] years; 217 [48.9%] female) who reported past-year e-cigarette use. 

According to the findings, 52 of the 444 youths (11.7%) reported at least 1 e-cigarette dependence symptom. Additionally, 43 youth participants (29.7%) answered that they used both e-cigarette and combustible cigarettes in the past year, which was more prevalent than e-cigarette dependence that was reported by 24 youths (16.4%). 

“The prevalence of e-cigarette dependence was higher among youth who reported vaping in the past month than among those who did not (41 youths [17.6%] vs 11 youths [5.2%]; P < .001) and among youth who used e-cigarettes with nicotine than among those who used e-cigarettes without nicotine (42 youths [15.2%] vs 10 youths [6.0%]; P = .004),” Dr Vogel and colleagues explained. 

Additional study findings showed that at the 6-month follow-up e-cigarette dependence symptom status was associated with the following:

• vaping continuation (adjusted odds ratio, 2.30 [95% CI, 1.07-4.94]; P = .02) and past 30-day number of nicotine vaping days (adjusted rate ratio, 2.17 [95% CI, 1.44-3.28]; P < .001);
• vaping sessions per day (adjusted rate ratio, 2.41 [95% CI, 1.52-3.83]; P < .001); and
• puffs per session (adjusted rate ratio, 1.70 [95% CI, 1.09-2.66]; P = .02).

The study authors found that among both combustible and e-cigarette dependence, common symptoms, craving, urge, and need to use, as well as least common symptoms, abstinence-related concentration, and emotional problems were similar in both groups. 

“These findings suggest that e-cigarette dependence may be an expression of tobacco use disorder associated with future use persistence and escalation among youth,” the study authors concluded.

“Electronic cigarette dependence may be a behavioral health consequence of adolescent vaping that warrants consideration in pediatric patient care and public health policy.” 

—Julie Gould

Reference:

Vogel EA, Cho J, McConnell RS, et al. Prevalence of electronic cigarette dependence among youth and its association with future use [published online February 19, 2020]. JAMA Netw Open. 2020;3(2):e1921513. doi:10.1001/jamanetworkopen.2019.21513